Review of Forensic Medicine

About the author: Dr.Sumit Seth,is a career diplomat,member of prestigous Indian Foreign Service.He happens to be the youngest post-graduate of Forensic Medicine in India. As Police Surgeon he has investigated and assisted more than 200 homicide cases(2000-2005) including high profile Phoolan Devi Murder Case. He has also contributed in several national and international academic publications.

Update ( 7 December 2011 ) : After discussion with some of the senior professors of Forensic Medicine, who confirmed that the answer key likely considered Spleen as the answer and cited the following reference from Post mortem technique handbook By Michael T. Sheaff, Deborah J. Hopster. ( Going by the Golden principle : Examiners are always right..I'm revising the answer from Brain to Spleen)

In the spirit of scientific temperament, please go through the 'Contradictory Reference' which points towards Brain Cortex : "
With blood samples, a good HMWDNA recovery from all the bodies
investigated was obtained during the first week following the death. In
each case, the quality and quantity of the DNA were good enough to
realize DNA fingerprints with the SLP
system (data not shown). In liver samples, only bodies of postmortem
ages ranging from 1 to 7 days allowed us to obtain HMWDNA. HMWDNA was
extracted from kidney samples up to one month after death, but the yield
of DNA decreased rapidly, becoming very low beyond a period of one
week. Past this period, we did not succeed in obtaining DNA fingerprints
from DNA extracted. The extraction of DNA from lymph nodes was
satisfactory up to one week. Over a postmortem period of 7 days, the DNA
was degraded and unsuitable for blotting. HMWDNA was purified from
spleen samples up to one week after death and the DNA present in heart
tissue or in muscle cells was stable up to one month postmortem period,
allowing us to perform DNA fingerprinting. Finally, out of all tissues
tested,the brain cortex appeared to be the most stable tissue for DNA
recovery, even after long postmortem periods." Source : http://library-resources.cqu.edu.au/JFS/PDF/vol_38/iss_3/JFS383930686.pdf

Study of the laterally extended curvedridges (Rugae) and the grooves on the anteriorpart of the palate.

It is also known as ‘Rugoscopy'
Palates have got various characteristics like placed
high up or low, broad or narrow. peculiarities of
the bony ridges and prominences.

Harrison Allen (1889) suggested the study of palate prints as a
method of identification.

Study of this method is advantageous because —
(1) Prints (ridge pattern) do not change during
growth.
(2) It is protected from trauma due to its
situation.
(3) It is protected from heat by bucal pad of
fat and tongue.
(4) Even in twins, the pattern of rugosities may
be similar but not identical.

Thomas and Kotze have classiﬁed palate
prints basing on the characteristic of the rugae as
follows -

According to organ transplantation act 1994 what punishment for doctor if found guilt ?

1. 2 yrs
2. more than 5 yrs
3. 4 yrs
4. 2-5 yrs

These has been an amendment in Organ Transplantation act in August 2011( both Lok Sabha & Rajya Sabha passed the Bill ) , where the punishment has been made more severe between 5-10 years (Click on Picture to enlarge view )...Why answe should be 2. more than 5 yrs? Explanation : Why will the examiner suddenly ask about punishment, if there is NO recent development )

Q A chronic alcoholic - assaults neighbor - had quit drinking 4 days back - now has delirium tremens. He is : A. Responsible for committing the crimeB. Not responsible under Sec 84 IPCC. Partially responsibleD. Responsibility can't be fixed from the given history ( Click on Picture to enlarge view )

2. What does the word "cardiac polyp" mean?

Cardiac Polyp : Mural thrombus in the right/left atrium at the time at the time of post-mortem examination appears as pedunculated mass with a stalk attached to wall of the heart and main mass in the lumen in cavity of the hear.

Q3. In civilnegligence, onus of proof is with

Doctorine of Burden of proof :

In criminal litigation, the burden of proof is always on the state. The state must prove that the defendant is guilty. The defendant is assumed to be innocent; the defendant needs to prove nothing. (There are exceptions. If the defendant wishes to claim that he/she is insane, and therefore not guilty, the defendant bears the burden of proving his/her insanity. Other exceptions include defendants who claim self-defense or duress.)

In civil litigation, the burden of proof is initially on the plaintiff ( patient in case of Medical Negligence suit) . However, there are a number of technical situations in which the burden shifts to the defendant. For example, when the plaintiff has made a prima facie case, the burden shifts to the defendant to refute or rebut the plaintiff's evidence.

Q. 4 A man working as a pest killer comes to opd with pain abdomen, garlic odor in breath & transverse meis lines on nails. What is diagnosis

1. LSD2. Cocaine psychosis
3. Canabis
4. Amphetamine

Magnan’s symptoms or cocaine bug is char­acteristic, in which there is feeling as if grains of sand are lying under the skin or some small insects are creeping on the skin (tactile hallucinations). This phenomenon is also known as formication. Some subjects report hallucinations of weak flashes of light, termed "snowlights."

Q.6 During autopsy, if spinalcord is to be examined what is the most commonly used approach

1. Anterior `
2. Posterior
3. Lateral
4. Antero-lateral

Explanation :

Most commonly used approach : Anterior

BEST approach to examine Spinal Cord: Posterior

Which approach used to open : Anterior, Posterior & Antero- lateral

Q. 7 Degrees awarded by Indian universities are mentioned in

RECOGNITION OF MEDICAL QUALIFICATION GRANTED BY UNIVERSITIES OR MEDICAL INSTITUTIONS IN INDIA.

1. The medical qualifications granted by any university or medical Institution in India which are included in the first Schedule shall be recognised medical qualifications for the purposes of this Act.

2. The medical qualifications granted by medical institutions outside India which are included in the Second Schedule shall be recognised medical qualifications for the purposes of this Act.

3. The medical qualifications granted by medical institutions in India which are not included in the First Schedule and which are included in Part I of the Third Schedule shall also be recognised medical qualifications for the purposes of this Act.

4. The medical qualifications granted by medical institutions outside India, before such date as the Central Government may, by notification in the Official Gazette, specify which are included in Part IInd of the Third Schedule shall also be recognised medical qualifications for the purposes of this Act

Explanation: The term “whiplash shaken-baby syndrome” was coined by Caffey to explain this constellation of infantile subdural and subarachnoid haemorrhages, traction-type metaphyseal fractures, and retinal haemorrhages and was based on evidence that angular (rotational) deceleration is associated with cerebral concussion and subdural haematoma ( being the MOST CHARACTERISTIC FEATURE of violent shaking of an infant by the Parent )

Tooth numbering system is used by dentists for uniquely identifying and referring to a specific tooth. Over the years, over 20 different teeth numbering systems have been developed. Today, general dentists use one of the following two major dental tooth numbering systems for the numbering of human teeth.

The Universal Numbering System is used primarily by most general dentists in the United States

FDI World Dental Federation notation is widely used by dentists internationally to associate information to a specific tooth.

A third system is the Palmer Notation Method that is used by some orthodontists, pedodontists and oral surgeons.

Sunday, January 02, 2011

It gives me immense pleasure to inform that the 4th International Edn is now available in book stores. I want to thank all students & readers for their encouragement and constant feedback. 15,000 copies of the earlier three editions were sold in a period of 5 years which is a record among the sale of short books on Forensic Medicine, making it a best seller.

This Book is now also available in Mauritius, Nepal, China, Pakistan and CIS countries apart from India.

Preview of the Book:

This Book has been extensively reviewed by Forensic Experts from USA,UK, Australia & India.

Their Reviews are as follows:

“It is really a simple and concise handbook on Forensic Medicine. It is awfully useful in homicide investigation for busy investigation officers.”

Shri Tajender Luthra, IPS

" This book is a must have for all pg aspirants, dr seth is both a great teacher & a great author"

Dr Sumer K Sethi,MBBS, MD (Radiodiagnosis)Course Director, DAMSDelhi Academy of Medical SciencesAuthor of famous "Review of Radiology' in same series

"Review of Forensic Medicine" is a concise book with lots of information on Forensic Medicine. I have used this book to prepare question for undergraduates during my stay at UPRIMS & R, Dr RPGMC, Tanda, and SNMC, Agra.The students were very much benefitted as they were also preparing for PG Entrance.

"The book is every student's delight as it has filled a void of a book that single-handedly covers all the topics in forensic medicine with the details precisely to an extent that is needed for the entrance examinations.It very well de burdens the pressures of time and learning expanse in the already overloaded and taxed life of a medical student."

A "can't afford to miss" book

I READ IT LIKE MY BIBLE

Dr. Parul GuptaTopper, Delhi PG Exam LADY HARDINGE MEDICAL COLLEGE

"REVIEW OF FORENSIC MEDICINE IS ONE OF THE BEST POCKET BOOKS FOR INDIAN MEDICAL GRADUATES, IT HAS ALL THE NEEDED POINTS IN LEAST NUMBER OF PAGES “

DR Isha GuptaTopper Pre-PG ExamLADY HARDINGE MEDICAL COLLEGE

The whole spectrum of forensic medicine is covered

The MCQs themselves are well thought out and laid out nicely.

On the whole it is a fine book suitable for students of forensic medicine

I would think that this book is the sort of book one reads one last time on the day before the exam!”

This slim volume is an excellent summary of the important points of forensic medicine.This is a user friendly book, easy and quick to read, and small enough to carry with you. It covers all fields of forensic medicine .It is an excellent companion to larger volumes on the forensic medicine and pathology.

Review of Forensic Medicine” by Dr. Sumit Seth (PEEPEE Publishers, New Delhi) is a refreshing departure from the traditional text books on Forensic Medicine. In each of the fourteen chapters of this small concise book the author has explained the intricacies of various facets of Forensic Medicine in a very simple and lucid manner followed by a set of possible Multiple Choice Questions with their answers at the bottom of each page.

Imprint or patterned abrasions may result from forceful impact, as in a pedestrian struck by a Vehicle. The importance of patterned abrasions lies in the fact that their shape can be matched to the causative object, and for this reason they should be documented by photography with a scale, or by an accurate tracing. Common examples of imprint abrasions are the sole patterns of footwear in kicking assaults, and motor vehicle tyre tread marks in run-over pedestrian deaths.

Explanation: Aluminum phosphide ( Celphos) toxicity appears to be due to release of PHOSPHINE on contact with moisture . This phosphine gas due to non competitive inhibition of cytochrome oxidase system of mitochondria or damage by free radicals causes global hypoxia.Significant inhibition of cytochrome-c oxidase activity can be found in ALP-poisoned patients
Organs with the greatest oxygen requirements appear to be especially sensitive to phosphine, including the brain, kidneys, heart, and liver. Phosphine has a characteristic odor described as "decaying fish. Cardiac dysrhythmias probably secondary to electrolyte imbalances have been described in sub-lethal acute exposures. Transient atrial fibrillation and sub-endocardial infarction, adrenocortical injury with elevated serum cortisol levels have been reported.

3) True about subendocardial hemorrhage are all except
a.) May be seen after head injuryb.) Involves RV WALL
c.) Continuous pattern
d.) Flame shaped hemorrhages

4) Spanish WINDLASS technique is a form of which type of execution?a) Garroting
b) Mugging
c) Bansdola
d) Hanging

Garroting was practiced in Spain

5).Pale infarct not seen in?

a. Kidney
b. Spleen
c. Heart d. Lung

Hemorrhagic Infarct of Lung

Explanation: Anemic infarcts (also called white infarcts) are white or pale infarcts caused by arterial occlusions, and are usually seen in the heart, kidney and spleen. These are referred to as "white" because of the lack of hemorrhaging and limited red blood cells accumulation, (compare to Hemorrhagic infarct). The tissues most likely to be affected are solid organs which limit the amount of hemorrhage that can seep into the area of ischemic necrosis from adjoining capillary beds. The organs typically include single blood supply (no dual arterial blood supply or anastomoses)

6) Wid marks formula

a) Alcohol
b) Time since death
c) Times since injury
d) Identification

New i-Phone application

Explanation: In order to calculate the Blood Alcohol Concentration, we must divide the weight of the alcohol by the weight of only the portion of the body that holds the alcohol, rather than the weight of the whole body. Widmark's original research, still valid today( check out the new i-Phone app), found that the average man's body can hold alcohol in even distribution in 68% of its weight. Widmark called this "0.68" factor his Widmark `r' factor. The lower-case "r" stands for "reduced body mass", or "reduzierte körpermasse".

7) 20 yr boy is having diarrhea, rhino rhea, sweating, what is the most probable diagnosis?

Explanation: Heroin Withdrawal symptoms: Restlessness, Insomnia, Diarrhea, Vomiting, Cold flashes with goose bumps, Kicking movements, Muscle and bone pain. Cocaine withdrawal symptoms (cocaine crash) : Fatigue, depression, restless behavior and a feeling of anxiety or paranoia.
Marijuana withdrawal: Irritability, anxiety, physical tension, increased aggression / anger, strange dreams.
LSD withdrawal: For LSD, the term withdrawal does not have the same meaning as for drugs that are habit-forming or addictive. While LSD use can rapidly lead to tolerance, it is not addictive.

• Doing a post-mortem on a suspected case of strangulation in-situ examination of neck structures is done before opening the skull and the chest

• Most important sign of strangulation is ligature mark.

• Fracture of Thyroid Cartilage is more common in strangulation by ligature.
– Mugging—Homicidal strangulation, by holding the neck in the bend of elbow.
– Bansdola—Strangulation with sticks (Homicidal strangulation)
– Garroting—Strangulation by twisting a lever like a tourniquet, homicidal strangulation.
(Traditionally was practiced in ‘SPAIN’ as a mode of execution.)

Throttling

1. Manual strangulation (always homicidal).
2. Fracture of the hyoid bone in 30-50% cases
• In Hyoid there is inward compression fracture*.
• The periosteum is torn on the outer side.
3. Fracture of the thyroid cartilage and of hyoid bone are usually found in above 40 years

Signs of Asphyxia
• Intense congestion and deep cyanosis of the head and neck is seen in strangulation
• The eyes wide open and pupils dilated
• The tongue swollen and protruded
• Petechial haemorrhages are common into the skin of the eyelids, face, forehead, behind the ears and scalp
• Blood stained froth may escape from the mouth and nostrils and there may be bleeding from nose and ears
• The intima of the carotid artery are not usually damaged
• Fracture of the thyroid cartilage is more common.

89. In freshwater drowning the death occurs within 4-5 minutes of submersion due to
ventricular fibrillation . Which of the following reasons is responsible for this ?

a. Total asphyxia produced due to fresh water
b. Laryngospasm causing vagal inhibition
c. Haemoconcentration of blood caused by the osmotic pressure effectd. Haemodilution, overloading of heart and haemolysis resulting in release of potassium

Explanation:

Drowning in Fresh Water
• Death in fresh water drowning in comparison to salt water is earlier .
• Drowning in fresh water leads to hemolysis and hemodilution, hyperkalemia and the cause of death is ventricular fibrillation.
• In fresh water drowning, chloride content of the left side of the heart is 50% lower

Drowning in Sea Water
• Due to high salinity of sea water (usually over 3% NaCl), water is drawn from blood into lung tissue, and produces severe pulmonary oedema and hypernatraemia, increase in magnisium ion.
• This causes haemoconcentration, the cause of death is Bradycardia.*
• In sea water drowning, chloride content of the left side of the heart is higher (Gettler’s Test)*.

Gettler’s Chloride test
– to differentiate fresh water drowning from sea water drowning
• Chloride estimation is not of any help after 12 hours
• It is not helpful in
o Putrefaction
o Patent Foramen Ovale
o Drowning in Brackish Water
-- Fresh water drowning, chloride content of the left side of the heart is 50% lower

90. Bevelling of the skull is seen in the:

a. Broad end of the entry point in bullet injury
b. Narrow end of the entry point in bullet injuryc. Exit point of bullet
d. Depressed fracture of the skull

Explanation

Beveling of the skull in bullet injury: The principle which guides the occurrence of beveling is that the bullet produces beveling in the second layer (or exit point).

• In entry wound the beveling is present in inner table of skull
• In exit wound the beveling is present in the outer table of skull

• This is usually limited to a single group of muscles and frequently involves hands;
• It mainly occurs in voluntary muscles.
• It cannot be produced by any method after death.
• It may be explained on the basis of diminished or exhausted ATP in the affected muscles.
• Rigor mortis simulates cadaveric spasm.

• Bullet is made up of lead.
• The extent of muscle damage by a bullet depends primarily on the velocity.
• Large round bullet causes greater damage to the body.
• A dumdum bullet, so called because tip is chiseled out, is one, which fragments extensively upon striking.
• Express bullet—Bullet in which a hole is present
o Tracer Bullet—Powder in the base so that it burns brightly*
• Incendiary bullets contain phosphorus.
• Souvenier Bullet—When the bullet remains in body for a long period of time is called souvenier bullet. It causes chronic lead poisoning.
• Glance bullet causes gutter fracture.
• Piggyback bullet—when bullet fails to come out from muzzy, this bullet is pushed by another bullet (Tandem bullet). In Tandom cartridge bullets are present in same cartridge which enters the target at different points.

In concentrated form Nitric Acid combines with organic matter and produces a yellow discoloration of tissue due to the production of picric acid (xanthoproteic reaction). The stomach is soft, friable and ulcerated and Brownish Discoloration. Perforation of stomach is not common.

96. Which of the following is a non-poisonous snake :
a. Viper
b. Krait
c. Sea snaked. Rat snake

• Spanish fly (blister beetle) is used externally as an irritant, and is commonly popular as an Aphrodisiac.(Reason for Priapism)
- The active principle is cantharidin.
- The Indian fly (beetle) contains about 3% cantharidin.
- Cantharidin is readily absorbed from all surfaces including the skin.

99. Which ofthe following section of IPC are concerned with dowry death :